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Low supply, asked to supplement, baby refused formula

I can't blame her LOL, but my LO is almost 11 months. She has been BF exclusively for 6; at 6 months we started introducing solids. Right now she eats solids 2-3 times a day. She is not great at eating solids, very picky but usually has yogurt, oat meal and banana+avokado mesh in a day.

At a last doctor's visit at 10 months, she was at 25% for weight, which dropped from 75% in 2 months. My doctor asked to supplement with formula.

After debating whether I should, I gave her some formula to try and she refused, making the saddest face.

I work from home. I pump once a day in the morning to make enough milk to add to oatmeal. I BF her between meals myself. She nurses at night still (1-2 times).

I used to get 5OZ with a pump, it recently decreased to 3.5, and today I only was able to make 1 OZ, which made me very concern. Is she getting enough when I BF her?

What advice can you give me? Should I increase my supply? How? What can I do to help her accept the formula? I gave her formula in a sippy cup.

Re: Low supply, asked to supplement, baby refused formula

Welcome to the forum!

Can you post your LO's weight history? I'm wondering if the issue here may be the charts your doc is using. The are several sets of charts in use these days. The are the old CDC charts, developed using data from primarily white, mostly formula-fed babies, and the newer WHO charts, developed using data from an ethnically diverse population of breastfed babies. The reason why the charts matter is that breastfed and formula-fed babies grow in different ways. Breastfed babies tend to gain weight relatively quickly during their first 6 months or so, and then slow way down in their second 6 months. Formula-fed babies have the opposite pattern; they grow slowly at first and then escalate in the second half of the first year. Measure a breastfed baby on a formula chart, and that baby will tend to appear to grow "too fast" during the first 6 months and "too slow" in the second 6 months.

Even if your baby is being measured on the right charts, weight is only one measure of normal growth. It's very common for breastfed babies to drop some percentiles, even on the breastfed baby charts, as they become more mobile and start devoting more calories to things like rolling, sitting up, crawling, etc. For example, both my girls zoomed up to the 95-99th percentiles on the weight charts between 0-4 months, and then dropped back to the 75-80th as they became more mobile. Many babies drop farther than that, and it's okay as long as they continue to grow in height and head circumference and to develop at a normal pace.

The drop in pump output you describe sounds very normal. 5 oz per pump session is in the overproduction zone. Most moms whose supplies are well-matched to their babies' demand make about 1.5 oz per hour. And most moms do find their their pump output declines with time, especially once their babies start solids and their milk intake decreases a little.

As long as you are not pregnant, not taking a new form of hormonal contraception, nursing on demand, and nursing at least 8 times a day, and the baby is continuing to grow in height and head circumference and to develop at a normal pace, I don't think I would be concerned. I might offer to nurse a little more often- older babies often become very distractible and forget to nurse enough- but I don't think I'd be offering formula just yet.

Re: Low supply, asked to supplement, baby refused formula

I don't have exact figures but at 10 month she was around 18 or so lb, at 8 month she was around 17, she only gained 1 lb in 2 months. I don't know what chart my doctor used but I would not be surprised if she used the old CDC chart (I didn't know there were different charts). I can call the doctor and get exact figures though, if needed. My daughter also was in 85%, kind of round chubby before she started moving and before starting solids. Now she moves around all the time, doesn't walk yet but crawls everywhere, and is beginning to walk. I DON'T BF her 8 times a day though, I BF her once after she wakes up, once during the day, once after work, once before bed, once or twice or not at all at night (this is not typical though, typically she wakes up to eat at night). I am not pregnant and am not taking any new contraception.

Re: Low supply, asked to supplement, baby refused formula

I don't understand what the concern is here. Both of my children were around that size at a year. The first one started out in 5%ile and stayed there - sometimes going up to 10%, dipping down to 3% at a year, I think. My second one started off at 50% and was around that same weight, but a bit larger, 25% at a year. I think you could offer to nurse a couple more times during the day - and how much solids is she eating? Do you think that she's eating too many (volume, not type) solids and just not hungry enough to nurse? Are the weekends pretty much the same as during the week? Is she happy and thriving?

Re: Low supply, asked to supplement, baby refused formula

You're reading it incorrectly, I think. At 12 months, 18 lbs would be in the 5th percentile on that chart. At 10 months, it's around the 25th percentile. More to the point, 17 lbs at 8 months is only just above the 25th percentile. In other words, this big scary drop between 8 and 10 months that your doc has you supplementing over- it's not that much of a decline!

Re: Low supply, asked to supplement, baby refused formula

This thread has been bugging me. So I went and looked up the old CDC chart, which you can see here: http://abbottnutrition.com/Downloads...ngthWeight.pdf. If you plot your LO's weight on that chart, then your LO does seem to decline from somewhere above the 50th %ile to somewhere around the 25th %ile. Aaaaand that's why the CDC itself now advocates that docs use the WHO charts, not the old CDC charts (see the CDC page, here: http://abbottnutrition.com/Downloads...ngthWeight.pdf)! Next time you go in, I suggest calling your doc on it. Who knows how many successful breastfeeding relationships are being sabotaged by improper chart use.